Convalescent troponin and cardiovascular death following acute coronary syndrome

• Published in: Heart (British Cardiac Society) Vol. 105; no. 22; pp. 1717 - 1724
• Main Authors: Adamson, Philip D, McAllister, David, Pilbrow, Anna, Pickering, John William, Poppe, Katrina, Shah, Anoop, Whalley, Gillian, Ellis, Chris, Mills, Nicholas L, Newby, David E, Pemberton, Chris, Troughton, Richard W, Doughty, Rob N, Richards, A Mark
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.11.2019; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research article
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Aged; Aged, 80 and over; Biomarkers; Biomarkers - blood; Cardiac Risk Factors and Prevention; Cardiology; Cardiovascular disease; Cause of Death; Clinical medicine; Disease prevention; Female; Heart attacks; Humans; Laboratories; Male; Middle Aged; New Zealand; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Statistical analysis; Task forces; Time Factors; Troponin I - blood; New Zealand; acute coronary syndromes
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2019-315084

ObjectivesHigh-sensitivity cardiac troponin testing is used in the diagnosis of acute coronary syndromes but its role during convalescence is unknown. We investigated the long-term prognostic significance of serial convalescent high-sensitivity cardiac troponin concentrations following acute coronary syndrome.MethodsIn a prospective multicentre observational cohort study of 2140 patients with acute coronary syndrome, cardiac troponin I concentrations were measured in 1776 patients at 4 and 12 months following the index event. Patients were stratified into three groups according to the troponin concentration at 4 months using the 99th centile (women>16 ng/L, men>34 ng/L) and median concentration of those within the reference range. The primary outcome was cardiovascular death.ResultsTroponin concentrations at 4 months were measurable in 99.0% (1759/1776) of patients (67±12 years, 72% male), and were ≤5 ng/L (median) and >99th centile in 44.8% (795) and 9.3% (166), respectively. There were 202 (11.4%) cardiovascular deaths after a median of 4.8 years. After adjusting for the Global Registry of Acute Coronary Events score, troponin remained an independent predictor of cardiovascular death (HR 1.4, 95% CI 1.3 to 1.5 per doubling) with the highest risk observed in those with increasing concentrations at 12 months. Patients with 4-month troponin concentrations >99th centile were at increased risk of cardiovascular death compared with those ≤5 ng/L (29.5% (49/166) vs 4.3% (34/795); adjusted HR 4.9, 95% CI 3.8 to 23.7).ConclusionsConvalescent cardiac troponin concentrations predict long-term cardiovascular death following acute coronary syndrome. Recognising this risk by monitoring troponin may improve targeting of therapeutic interventions.Trial registration numberACTRN12605000431628;Results.